Key points:

  • On 30th Sept 2015 there were 1414 substantive gastroenterology consultants in the UK, a 6.6% expansion from 30/09/14. The mean annual expansion over the last 10 years has been 4.9% per year but this is lower that it could have been as there are 42 locum consultants in post, and 51% of advertised consultant posts were not filled (despite there being 100 UK CCT holders without a substantive consultant post).
  • In 2013 the RCP predicted that we need 6 whole-time equivalent consultants per 250,000 population (1 per 41,667) doing 11.5 PAs of gastroenterology & GIM, a total of 1516 consultants (102 more). As 14% of consultants work less than whole time (6.7 PAs on average) we need a total of 1610 consultants (1 per 39,243 population) or 196 more. If expansion continues at 5% per year then this will take 2-3 years to achieve. However, the UK population is expanding and aging and there have been major service changes that were not included in the 2013 figures (e.g. bowel scope & FiT testing, out of hours bleed rotas, 7 day services and increased access to endoscopy) so further expansion will be required.
  • Over the last 5 years our gastroenterology & hepatology training programmes have produced an average output of 99 CCTs per year. Once predicted retirement posts have been replaced, this number is sufficient to produce a consultant expansion rate of 5.6% next year.
  • The number of attempted consultant appointments in the UK (excluding Scotland) increased 77% in 2014 compared to the average from 2008-2011. There has been a 21% increase in successful appointments but a 312% increase in unfilled posts in the same time frame as CCT output has not changed to match the demand.
  • There remains significant regional variation in consultant gastroenterologist provision in the UK; North East England & London have exceeded the RCP recommended number per population. South East Coast/South Central England, East Midlands and East of England have the least consultant gastroenterologists per population. There is also regional variation in the number of trainees per population. There is a higher than average density of trainees to population in London, the North East and the West Midlands, whereas Wales, Yorkshire & Humber and the South West have the least number of trainees per population. Redistributing NTN posts to areas of consultant under-provision or those with recruitment difficulty could help consultant recruitment in these areas.
  • The proportion of female gastroenterology consultants is the same as 2014 (18% consultants) but the proportion of female trainees has increased (39% trainees are female compared to 37% in 2014) although both remain much lower than other medical specialties (33% UK consultant physicians, 52% medical higher specialty trainees female), medical students (57%) and doctors in training (54%) presumably as some females struggle to see how GIM & endoscopy on call rotas are compatible with family life.  Encouraging LTWT training & working and flexibility of job planning would help. This would also help older consultants who wish to return to work after taking their pensions.
  • There is a shortfall of 300 CMT posts below requirements so it is impossible to fill medical ST3 posts beyond the 70-80% level. Gastroenterology remains a popular specialty filling 100% NTN posts but only 48% of advertised LAT posts resulting in gaps in training programmes. Health Education England (HEE) has no plan to increase the number of CMT posts in 2016/17 as all available funding is being used to create more GP training posts and without additional foundation trainees, they probably wouldn’t be filled.
  • There will be no change in the number of gastroenterology or hepatology NTNs in 2015/16 but HEE have abolished LATs in England. This may drive trainees to take an NTN in their second choice specialty rather than a service post in gastroenterology in England or a LAT in a devolved nation, which could reduce gastroenterology CCT output (inhibiting consultant expansion) and cause rotation gaps unless the number of NTNs posts is increased to compensate. HEE have suggested this as a possible option where there are sufficient applicants and training capacity, and where an increased output of trained gastroenterologists is required.  This is not likely to apply in London.